Association of Sick Sinus Syndrome with Incident Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

Background

Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population.

Methods

We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes.

Results

During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14–1.70), coronary heart disease (HR 1.72, 95%CI 1.11–2.66), heart failure (HR 2.87, 95%CI 2.17–3.80), stroke (HR 1.56, 95%CI 0.99–2.46), AF (HR 5.75, 95%CI 4.43–7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9–67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51–2.66), AF (HR 4.25, 95%CI 3.28–5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8–32.1).

Conclusion

Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation.     

Fibrinogen,Other Putative Markers of Inflammation,and Weight Gain in Middle‐aged Adults—The ARIC Study

Purpose: Weight gain is an important risk factor for the development of the metabolic syndrome, and inflammatory mediators are strongly associated with this syndrome. Our aim was to investigate whether inflammation predicts the development of weight gain in populations. Research Methods and Procedures: We investigated selected markers of inflammation in the prediction of weight gain over an approximately 3‐year period in a biethnic cohort of 13,017 men and women, 45 to 64 years of age, using multiple linear and logistic regression modeling. Results: In adjusted models, those in the highest quartile of fibrinogen gained, during the first 3 years of follow‐up, an estimated 0.23 kg/year more than those in the lowest quartile (p < 0.001). Adjusted odds of a large (greater than the 90th percentile) weight gain for those in the highest quartile of fibrinogen were 1.65 (95% confidence interval [CI], 1.38 to 1.97) times those in the lowest quartile. Similarly adjusted odds ratios for a large weight gain for those with high levels of white blood cell count, factor VIII, and von Willebrand factor were 1.38 (1.14 to 1.67), 1.28 (1.08 to 1.53), and 1.28 (1.08 to 1.51), respectively. Discussion: Fibrinogen and other putative markers of inflammation predict weight gain in middle‐aged adults. Given the known links between the inflammatory response and intermediary metabolism and the methodological strengths of the Atherosclerosis Risk in Communities (ARIC) cohort, these findings, though without immediate clinical applicability, suggest that inflammatory processes play a role in the development of the metabolic syndrome and cardiovascular disease in part through stimulation of weight gain.     

History of Intentional and Unintentional Weight Loss in a Population-Based Sample of Women Aged 55 to 69 Years

FRENCH, SIMONE A, ROBERT W JEFFERY, AARON R FOLSOM, DAVID F WILLIAMSON AND TIM BYERS. History of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. Obes Res. 1995;3:163–170. Although both overweight and body weight fluctuation are related to chronic disease risk, little is known about the history of and reasons for body weight change in the general population. This paper reports the incidence of intentional and unintentional weight loss episodes during adulthood in a population-based sample of 26, 261 women aged 55 to 69 years. Intentional weight loss episodes of each of four amounts (5–9, 10–19, 20–49, 50+ lbs.) and unintentional weight loss episodes of 20 or more lbs. were recalled for each of three age periods (18–39, 40–54, 55+ years). At least one intentional weight loss episode of 5 or more lbs. was reported by 69% of women, 46% reported at least one intentional weight loss episode of 10 or more lbs, and 25% reported at least one intentional weight loss episode 20 or more lbs. At least one unintentional weight loss episode of 20 or more lbs. was reported by 29% of the women. Reasons for weight losses of 20 or more lbs. were also recalled. Women who had intentionally lost 20 or more lbs. were more likely to report weight losses due to low-calorie diets, exercise and weight loss groups, while women who had unintentionally lost 20 or more lbs. were more likely to report weight losses due to depression or stress. These findings question the common assumption that weight losses in adult women are primarily intentional and emphasize the need to distinguish the reasons for weight loss in studies examining the relationship between body weight changes and health outcomes.     

A histological and immunohistochemical study of the effects of N-acetyl cysteine on retinopathy of prematurity by modifying insulin-like growth factor-1

Retinopathy of prematurity (ROP) is a vasoproliferative disorder that occurs in premature infants and may lead to permanent visual impairment. We investigated both the possible protective role of N-acetyl cysteine (NAC) for preventing ROP and the role of IGF-1 in the disorder. Forty-five newborn rats were divided into three groups. Group 1 was raised in room air as controls. Group 2 was exposed to 60% oxygen for 14 days after birth, then transferred to room air. Group 3 was exposed to the same conditions as group 2, but received intraperitoneal injections of NAC on postnatal days 7–17. After 35 days, both eyes of all rats were processed for histology. Some sections were stained with hematoxylin and eosin to assess structural changes and other sections were immunostained to determine the location of IGF-1. Frozen sections also were prepared and stained for adenosine triphosphatase to detect retinal blood vessels. Compared to the controls, more blood vessels, many of which were abnormal, and increased IGF-1 expression were observed in group 2. In group 3, abnormal blood vessels and IGF-1 expression were less evident. NAC appeared to be an effective vascular-protective agent for ROP by decreasing IGF-1 expression.     

Trypsin-induced calcium efflux from sarcoplasmic reticulum: Evidence for the involvement of the (Ca2++Mg2+)-ATPase

Summary Trypsin digestion of the sarcoplasmic reticulum membrane at 35 to 43°C leads to an increased calcium permeability, the temperature dependence of which suggests tryptic exposure or creation of a channel rather than tryptic release of a mobile carrier (K.C. Toogood et al.,Membr. Biochem. 5:49–75, 1983). Here we show that: (1) the digested vesicles both pump and leak calcium, demonstrating that the vesicles remain intact; (2) an increased rate of efflux is not observed for membranes digested and kept at 15°C, but a temperature shift to 35°C following arrested digestion leads to the development of increased calcium permeability, indicating that a digestion step at the lower temperature potentiates increased permeability which develops rapidly as a result of a trypsin-facilitated protein conformational change at the higher temperature; (3) two inhibitors of the ATPase, adenyl-5-yl imidodiphosphate and dicyclohexyl-carbodiimide, both measurably retard the development of increased permeability at the higher temperature following arrested digestion, suggesting that these inhibitors bind to the target protein and prevent the conformational change responsible for the permeability increase, and further suggesting that the ATPase is the target for the trypsin; (4) digestion of the ATPase at 15°C follows the same initial cleavage pattern as at 35°C, but the cleavage stops or drastically slows down after the second digestion step at the lower temperature, whereas the digestion continues beyond the second step at the higher temperature, showing that an early digestion step may be responsible for potentiating increased permeability; (5) the permeability increase following digestion at 15°C and incubation at 35°C correlates (r>0.98) with the second tryptic cleavage step of the calcium ATPase, providing more support for the ATPase as the trypsin-sensitive efflux site; and (6) the rate of efflux depends on the concentration of the doubly cleaved ATPase molecules to the first power; the null hypothesis that the efflux actually depends on the cleaved ATPase concentration to the second or higher power was examined using the F test and can be rejected (confidence>0.90 to 0.98), suggesting that the efflux pathway is through a single ATPase molecule. We speculate that the pathway for increased calcium permeability is the one employed during calcium uptake and that there is a functional separation of the ATPase and calcium channel activities by trypsin digestion at 15°C followed by incubation at 35°C.     

Conserved sequences in enzymes of the UDP-GlcNAc/MurNAc family are essential in hamster UDP-GlcNAc:dolichol-P GlcNAc-1-P transferase

The UDP-GlcNAc/MurNAc family of eukaryotic and prokaryotic enzymes use UDP-GlcNAc or UDP-MurNAc-pentapeptide as donors, dolichol-P or polyprenol-P as acceptors, and generate sugar-P-P-polyisoprenols. A series of six conserved sequences, designated A through F and ranging from 5 to 13 amino acid residues, has been identified in this family. To determine whether these conserved sequences are required for enzyme function, various mutations were examined in hamster UDP- GlcNAc:dolichol-P GlcNAc-1-P transferase (GPT). Scramble mutations of sequences B-F, generated by scrambling the residues within each sequence, demonstrated that each is important in GPT. While E and F scrambles appeared to prevent stable expression of GPT, scrambling of B- D resulted in GPT mutants that could be stably expressed and bound tunicamycin, but lacked enzymatic activity. Further, the C and D scramble mutants had an unexpected sorting defect. Replacement of sequences B-F with prokaryotic counterparts from either the B.subtilis mraY or E.coli rfe genes also affected GPT by preventing expression of the mutant protein (B, F) or inhibiting its enzymatic activity (C-E). For the C-E replacements, no acquisition of acceptor activity for polyprenol-P, the fully unsaturated natural bacterial acceptor, was detected. These studies show that the conserved sequences of the UDP- GlcNAc/MurNAc family are important, and that the eukaryotic and prokaryotic counterparts are not freely interchangeable. Since several mutants were efficiently expressed and bound tunicamycin, yet lacked enzymatic activity, the data are consistent with these sequences having a direct role in product formation.      

The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987–2001

Background

We have developed a rat cell model for studying collagen type I production in coronary artery adventitial fibroblasts. Increased deposition of adventitial collagen type I leads to stiffening of the blood vessel, increased blood pressure, arteriosclerosis and coronary heart disease. Although the source and mechanism of collagen deposition is yet unknown, the adventitia appears to play a significant role. To demonstrate the application of our cell model, cultured adventitial fibroblasts were treated with sex hormones and the effect on collagen production measured.

Methods

Hearts (10–12 weeks) were harvested and the left anterior descending coronary artery (LAD) was isolated and removed. Tissue explants were cultured and cells (passages 2–4) were confirmed as fibroblasts using immunohistochemistry. Optimal conditions were determined for cell tissue harvest, timing, proliferation and culture conditions. Fibroblasts were exposed to 10^-7 M testosterone or 10^-7 M estrogen for 24 hours and either immunostained for collagen type I or subjected to ELISA.

Results

Results showed increased collagen staining in fibroblasts treated with testosterone compared to control and decreased staining with estrogen. ELISA results showed that testosterone increased collagen I by 20% whereas estrogen decreased collagen I by 15%.

Conclusion

Data demonstrates the usefulness of our cell model in studying the specific role of the adventitia apart from other blood vessel tissue in rat coronary arteries. Results suggest opposite effects of testosterone and estrogen on collagen synthesis in the rat coronary artery adventitial fibroblasts.     

Quantification of angiogenesis in estrogen receptor-positive and negative breast carcinoma

Background

The objective of this study was to evaluate angiogenesis according to CD34 antigen expression in estrogen receptor (ER)-positive and negative breast carcinomas.

Methods

This study comprised 64 cases of infiltrating ductal carcinoma in postmenopausal women divided into two groups: Group A: ER-positive, n = 35; and Group B: ER-negative, n = 29. The anti-CD34 monoclonal antibody was used as a marker for endothelial cells. Microvessel count was carried out in 10 fields per slide using a 40× objective lens (magnification 400×). Statistical analysis of the data was performed using Student's t-test (p < 0.05).

Results

The mean number of vessels stained with the anti-CD34 antibody in the estrogen receptor-positive and negative tumors was 23.51 ± 1.15 and 40.24 ± 0.42, respectively. The number of microvessels was significantly greater in the estrogen receptor-negative tumors (p < 0.001).

Conclusion

ER-negative tumors have significantly greater CD34 antigen expression compared to ER-positive tumors.

     

Complement C3c and related protein biomarkers in amyotrophic lateral sclerosis and Parkinson's disease

We have used quantitative 2D gel electrophoresis to analyze serum proteins from 422 patients with neurodegenerative diseases and normal individuals in an unbiased approach to identify biomarkers. Differences in abnormal serum levels were found between amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), and related disorders for 34 protein biomarker spots, nine of which were related to the complement system. Of these nine, four spots originated from the Complement C3b-alpha-chain (C3c(1), C3c(2a), C3c(2b), and C3dg). The C3c spots (C3c(1), C3c(2a), and C3c(2b)) had the same amino acid sequence and glycosylation, though only C3c(1) was phosphorylated. In addition, Complement Factors H, Bb, and Pre-Serum amyloid protein displayed different serum concentrations in ALS, PD, and normal sera, whereas Complement C4b gamma-chain and Complement Factor I did not. The differential expression of the complement proteins provides potentially useful biomarkers as well as evidence for the involvement of inflammatory processes in the pathogenesis of ALS and PD.